Title 4. Public Care Systems. - Chapter 8. Medicaid Provider Fraud Prevention. - § 4-802. Penalties; prohibited acts.


Published: 1985

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now for only USD$20 per month, or Get a Day Pass for only USD$4.99.

§ 4-802. Penalties; prohibited acts.

  • Current through October 23, 2012

(a) A person shall be guilty of a misdemeanor punishable by a fine of not more than $500 or imprisonment not to exceed 1 year, or both, for each violation of the following prohibitions in this section.

(b) No one may, with intent to defraud, by means of a false claim, false statement, failure to disclose information, or other fraudulent scheme or device, obtain or attempt to obtain:

(1) Authorization to become or remain a provider;

(2) A higher rate of payment than that to which the person is entitled as a provider;

(3) Payment, as a provider, for items or services that the person knows or has reason to know were not provided as claimed;

(4) Payment which may not be made under the program under which the claim was made; or

(5) Payment submitted in violation of an agreement between the person and the District of Columbia.

(c) No one may solicit, accept, or agree to accept any type of remuneration for the following:

(1) Referring a recipient to a particular provider of any item or service or for which payment may be made under the District of Columbia Medicaid Program; or

(2) Recommending the purchase, lease, or order of any good, facility, service, or item for which payment may be made under the District of Columbia Medicaid Program.

(d) No one may confer, offer, or agree to confer or offer any type of remuneration for the conduct described in subsection (c) of this section.

(e) No one may charge, solicit, accept, or attempt to charge, solicit, accept or receive anything of value from a recipient or provider in addition to the amount of money payable under the District of Columbia Medicaid Program.

(f) No one may solicit, receive, or attempt to solicit or receive anything of value as a precondition for admitting a recipient to a hospital, skilled nursing facility, intermediate care facility, or any other facility, or as a condition for providing any item or service to a recipient.

                                

(Mar. 16, 1985, D.C. Law 5-193, § 3, 32 DCR 1010.)

HISTORICAL AND STATUTORY NOTES

Prior Codifications

1981 Ed., § 3-702.

Legislative History of Laws

For legislative history of D.C. Law 5-193, see Historical and Statutory Notes following § 4-801.